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Hosseini S. A. 1, Labaf A. 2, Kord Valeshabad A. 3, 4, Dabiran S. 5
1 Department of Emergency Medicine Imam Reza Hospital Kermanshah University of Medical Sciences Razi blvd, Kermanshah, Iran;
2 Department of Emergency Medicine Tehran University of Medical Sciences Tehran, Iran;
3 Farzan Clinical Research Institute, Tehran, Iran;
4 Students Research Center Tehran University of Medical Sciences Tehran, Iran;
5 Department of Epidemiology Tehran University of Medical Sciences Tehran, Iran
Aim: This study was designed to assess the effectiveness of scapular manipulation for reducing anterior shoulder dislocation in a setting to administrate premedication based on the patients’ initial pains.
Methods: In this case-series study all consecutive cases clinically suspicious to anterior shoulder dislocation presented at emergency department of Imam Khomeini Hospital, Tehran, Iran between April 2006 and February 2009 were recruited. Patients’ pains at rest and during reduction procedure were recorded. Patients with severe pain at rest received intravenous premedication prior manipulation and those with mild or moderate pain did not receive any drug. Scapular manipulation was performed in prone position. Patients’ and physicians’ satisfaction of reduction maneuver was measured using adjective score.
Results: Of 49 initial patients, finally 33 patients (30 men, 3 women) with the mean age of 33.2±11.4 years underwent reduction maneuver. Among the patients, 19 dislocations (73.1%) were performed without analgesia. The success rates in our study were 69.6% and 30.0% in the first and second attempts and 78.8% overall. The higher success rate was detected in ages < 30 years (100% vs. 53.55%, P=0.001), height > 173 cm (93.2% vs. 64.7%, P=0.04) and recurrent dislocation (88.4% vs. 42.85%, P=0.009).
Conclusion: Scapular manipulation even in absence of analgesia is safe, rapid and easy technique for reduction of anterior shoulder dislocation especially in young patients with recurrent dislocation. It is more logical to classify patients based on their initial pains to receive or not-receive premedication prior scapular manipulation.